Clinical Reviewer - Indiana Licensed

Job Summary

A company is looking for a Clinical Reviewer - LPN/LVN or RN (Remote U.S.).

Key Responsibilities

• Review medical records for accuracy and compliance with contract and regulatory standards
• Assess and manage daily workload, adjusting schedules to meet departmental demands
• Serve as a liaison for customer service issues and maintain professional relationships with internal and external stakeholders

Required Qualifications

• Active, unrestricted LPN/LVN or RN license in Indiana or a Compact state
• 3+ years of clinical experience in acute, behavioral health, or med-surgical environments
• 2+ years of experience in Utilization Review/Management and/or Prior Authorization
• 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines
• Proficient in navigating multiple systems and strong clinical assessment skills